The primary goal of this study is to examine how Certified Nurse Assistants (CNAs) respond and adapt to the death of nursing home residents. This information has important implications for CNAs'continued tenure and ability to provide high quality care. Issues of dying, grief, and loss are extremely pertinent in the nursing home context. However, long-term care facilities typically provide little support, structure, or ritual to help staff through this time (Moss &Moss, 2002). This lack of attention regarding an issue that is a normative aspect of work life for long-term care staff may contribute to the extremely high turnover rate in this population that is consistently reported. The cost of turnover in CNAs, the principal caregivers in nursing homes, is estimated at $4 billion per year in the US (National Commission on Nursing Workforce for Long-Term Care, 2005). Evidence from a few exploratory studies suggests that long-term care staff experience some degree of grief in response to resident loss (e.g., Wilson &Daley, 1998). Yet, none of these studies provide a systematic assessment of grief and grief processing, and they fail to link assessments to particular deaths. Second, most do not focus on CNAs, the front-line staff in nursing homes who have the closest contact with the residents, and therefore have a tremendous impact on residents'life quality (Yeatts &Cready, 2007). Finally, few studies link grief-related staff responses with important employment-related outcomes (e.g., staff turnover), as well as examine the individual and institutional factors that predict these outcomes. The proposed research seeks to fill this void. Specific aims are: 1. To examine grief symptoms and grief processing in CNAs after the death of a resident in their care, and the extent to which these experiences parallel the experience of bereaved family members documented in prior research;2. To investigate the relationship between grief- related and employment-related outcomes (e.g., job retention, absenteeism, impact of loss on work);3. To determine how CNA-, resident-, and institutional factors are linked to grief- and employment-related outcomes, and to identify which of these are the strongest predictors of these outcomes. Participants will be 120 CNAs who provide nursing home care to residents of one of the largest health care providers for elders in New York State. Data will be collected through in-person interviews. The study has a mixed methods design, with both open and structured interview parts, and qualitative and quantitative data coding and analyses. The proposed research will provide the empirical knowledge base to adequately identify staff who are in need of support after the death of a resident, and to design support interventions based on empirically identified modifiable factors (e.g., development of rituals;support groups) that can successfully address this need. Our long-term research goals are: 1) to seek funding for a larger, longitudinal study of grief among CNAs, and 2) to conduct a randomized clinical trial to test a support intervention for CNAs based on empirical findings and CNA identified needs and determine effects on employment satisfaction and retention, as well as ability to cope with bereavement and to bond with other residents. PUBLIC HEALTH RELEVANCE: High quality care in nursing homes is an important public health need. As the front-line staff in nursing homes, certified nursing aides (CNAs) have the closest contact with the residents and therefore have a tremendous impact on residents'life quality. Issues of dying, grief, and loss are a normative aspect of their work life that may contribute to the extremely high turnover rate in this population. Thus, a better understanding of how CNAs respond to the death of residents, and what kind of support they may need, has important implications for the delivery and quality of care provided in nursing homes.